HOSPITAL VARIATION IN QUALITY OF BIRTH CARE IN DENMARK

HOSPITALS VARIATION I KVALITEN AF FØDSLER I DANMARK

Groth, Margrethe

4. term

Medicine with Industrial Specialisation, Master

2022

2022-06-01

49

Baggrund: Andelen af kejsersnit er steget globalt. Akut kejsersnit kan medføre komplikationer som blødning, infektioner, risiko for barnet og øget risiko ved senere graviditeter og fødsler. Formål: At undersøge, hvor meget brugen af akut kejsersnit varierer mellem danske hospitaler. Metode: Risikofaktorer blev identificeret via litteraturen, og en Directed Acyclic Graph (DAG) blev brugt til at bestemme, hvilke forhold der skulle justeres for for at håndtere konfunderende faktorer. Data omfattede 65.996 kvinder i Robson-gruppe 1 eller 2a (førstegangsfødende med et enkelt barn i uge 37 eller derover, som planlagde vaginal fødsel) fra registrene DNQDB og BEF. Vi beregnede ujusterede og justerede IRR (et statistisk mål, der sammenligner hyppighed) for regioner og hospitaler. Derudover lavede vi en eksplorativ analyse, hvor kvinder med medicinske tilstande og rygere blev udeladt, og beregnede justerede IRR for denne delgruppe. Resultater: Der var variation i brugen af akut kejsersnit mellem hospitaler. Efter justering for moderens alder, BMI og sociale forhold var der færre hospitaler, der afveg statistisk fra Rigshospitalet. Det indikerer, at en del af variationen kan hænge sammen med forskelle i patienternes karakteristika, men at risikoen for akut kejsersnit stadig varierer efter fødested blandt førstegangsfødende med et enkelt barn ved termin, som planlagde vaginal fødsel. Variationen så ikke ud til at være forklaret af medicinske tilstande.

Background: Cesarean section rates have risen worldwide. Emergency cesareans can lead to complications such as bleeding, infections, risks to the baby, and higher risks in later pregnancies and births. Aim: To estimate how much the use of emergency cesarean (acute CS) varies between Danish hospitals. Methods: Risk factors were identified from the literature, and a Directed Acyclic Graph (DAG) was used to decide which factors to adjust for to address confounding. Data included 65,996 women in Robson groups 1 or 2a (first-time mothers with a single pregnancy at 37 weeks or more, planning a vaginal birth) from the DNQDB and BEF registries. We estimated unadjusted and adjusted IRRs (a statistical measure comparing rates) for regions and hospitals. We also conducted an exploratory analysis excluding women with medical conditions and smokers and estimated adjusted IRRs for this subgroup. Results: We observed variation in the use of emergency cesarean across hospitals. After adjusting for maternal age, BMI, and socioeconomic measures, fewer hospitals differed statistically from Rigshospitalet. This suggests that part of the variation relates to patient characteristics, yet the risk of emergency cesarean still varies by hospital among first-time mothers with a single term pregnancy planning a vaginal birth. The variation did not appear to be explained by medical conditions.

[This summary has been rewritten with the help of AI based on the project's original abstract]

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